Poster-01-080Study of Microinvasive Squamous Cell Carcinomas of The Cervix in Figo Stage IA1 in the Canaries University Hospital Maternity Ward Objective: Retrospective study of microinvasive squamous cell carcinomas of the cervix in FIGO stage IA1, diagnosed at the Pathology of the Lower Genital Tract Unit of the Canaries University Hospital Maternity Ward during the period 1991-2007. Method: We analyzed 62 cases of microinvasive squamous cell carcinomas of the cervix in FIGO stage IA1. Patients were referred upon abnormal cytology results or upon high-grade histological findings. They underwent cytology, colposcopy examination and biopsy when necessary. Subsequently, excision treatment with diathermy loop cone was applied and all diagnoses were determined in the specimen. The studied variables included: age, initial reason for consulting, status of the specimen margins, fragment of the endocervical canal when biopsy was performed and the histological findings of patients who underwent a second treatment. Finally, we analyzed the post-surgery follow-up periods. Results: Patients’ average age was 41 years (26-68 years). The follow-up period ranged between 6 and 128 months, with an average time of 82 months. The most frequent initial reason for consulting was HSIL, with a total of 83% of high-grade lesions and 17% cases of low-grade lesions. All cases of microinfiltrating carcinomas were diagnosed on the first conization specimen, except for one case, which was diagnosed in the second cone (indicated by CIN III, involved margins). The margins were free of lesions in 49% and affected by the high-grade lesions in 51%: 28.2% of exocervical margin involvement, 37.5% of endocervical margin involvement and 34.3% of both margins involvement. Endocervical canal biopsy was carried out after conization in 46.7%. Results were negative for 86.2% of them. There were two cases (3.2%) of vascular invasion – both treated with radical hysterectomy – and in one case there was a diagnosis of synchronic endometrial adenocarcinoma. 64.5% of patients (40/62) underwent a second treatment; the most frequent one was hysterectomy (37 cases), followed by conization (4 cases) and radiotherapy in one case because of high risk associated to surgery. The second treatment was applied to 28 patients with involved margins (4 cases of involved margins with negative results of the endocervical canal fragment were followed-up with expectancy because of the patients’ will of pregnancy), 4 cases with margins that could not be examined and 8 cases with margins free of lesions. The outcome of the second treatment was: 55% without residual tumor, 15% of CIN I, 15% of CIN III, 5% of microinvasive carcinoma, 5% of non-gradable CIN, 2.5% of isthmus adenocarcinoma, and 7.5% whose results could not be found. All high-grade lesions detected upon the second surgical treatment corresponded to patients whose specimens had already showed involved margins upon the first conization. In general, only 22.5% of treated cases presented high-grade lesions. Conclusion: Microinvasive epidermoid carcinomas stage FIGO IA1 can be managed with a conservative treatment, independently of the patient’s will of pregnancy, so that if the specimen’s margin remain uninvolved, a second excision procedure is not necessary. In case of involved margins, individual circumstances should be considered in evaluating the suitability of a second conization. |
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